Call me naive, but maybe someone could explain something to me:
Why, in our profession, is it considered advanced NURSING practice to leave the bedside? The ADN goes in, does a shift, cares for his or her patient load, uses all their competency to care for real people in real beds.
But then the BSN comes along and wants to be manager, and that's considered "more professional." But that BSN isn't at the bedside anymore.
But then the BSN becomes an NP, and now they're practicing low-skilled medicine, which isn't nursing at all! But they are the "Advanced Practitioners?"
I understand nurses at the bedside. I understand, perhaps older nurses who can't do the physical stuff anymore, getting advanced degrees so they can teach nursing. And I get that someone on any unit, has to be the manager. But all of that focuses on the support and instruction of the bedside nurse.
Seriously, wouldn't technical nursing certifications like ACLS and CCRN (or the other specialty certifications) really be what makes a nurse "Advanced."
I mean if my name looks like this:
EGspirit, MS, APRN, ACNS-BC, CEN, FAWM, FAAN
am I even a nurse anymore?
Why can't caring be the profession and leave medicine and surgery to the doctors, and the Ph.Ds to the Nursing school professors? Wouldn't being really good at running a code or starting an IV, or even being really effective at feeding and bathing a patient be the definition of the advanced nurse?
Why in our profession are we always running away from the bedside? I mean, why be in the profession?
Just wondering and looking for opinions on the matter.
If you want to provide personal care, you can always go to school to become a Certified Nurse Assistant (CNA); this is a great path. I have a tremendous amount of respect for CNAs.
Not true. I tried to go back to being a tech. The closest I felt to God was when I was a CNA in the dungeon of a nursing home where I first started. But I've been told by two different hospitals in my area that they will not hire a nurse as a tech--they say they can't.
And I take that as a sign that the calling I received to be an RN is something I have to live up to whether I want to or not. But I envy the CNAs. Or at least I envy their position in the spiritual scheme of things.
In my opinion, a CNA who works at the same pace I do for my patients is better than me. You won't ever understand that. It's lost on you, I know it. I'm not judging you for that--it's just a fact.
I am an APRN, and I am at the patient's bedside regularly in my Psych NP practice. Hoping to find an empty chair in their room, so I can sit down comfortably, and discuss their mental health issues.
That being said, many Nursing jobs away from the bedside offer better pay, better hours, no holidays or weekends, and much less physical labor. Can you blame people from wanting to escape those conditions?
No, I can't blame them. I fully understand it. But even you, in this post, make it clear that you ARE at the beside of your psych patients. And that's my whole case in point. Let us give the most respect where the most respect is due. The more direct the patient care, the more the honor and glory should be. And frankly, I think that should be the rule with doctors and social workers as well. But those aren't my fields, so I can't really make a statement about them.
And because I am a leaver-of-the-bedside, because it was that or leave the only profession I know, I would like to know how you suggest the world fill all the non-bedside nursing positions?
There's no such thing. Anything not at the bedside can be done by non-nurses, and probably better. WITH THE EXCEPTION (as I mentioned in the OP) of the unit manager or the nursing school teacher, but both of those roles are in direct support or manufacturing of the bedside nurse. And those should be reserved for the older or less physically capable nurses.
As for me being judgmental. I'm not judging any individual in here. This is a discussion post about a broad subject matter. So, don't try to impugn my Christianity for the case I'm trying to make in this post as if somehow that will shame me into shutting up.
Individuals are individuals. I judge no individual. I'm talking about the broad concept of what is or is not an "advanced" practice nurse.
Besides, God knows there are much better reasons to believe I'm a bad Christian (pun intended).
I just have to say this, and I SHOULD PUT IT IN ALL CAPS. NPs are not MDs. They don't compare. They are a physician's assistant. They are nurses taken from nursing care and used primarily to assist a physician. They work under the supervision of a physician. When I go to the doctor, sometimes I see the MD, sometimes I see the NP. There is an obvious difference.
You can put it in ALL CAPS or bold or italics but you are still absolutely wrong. NPs are not MDs nor are they PAs nor do they exist to "primarily assist" a physician. If you want to underline your ignorance, feel free, but it doesn't make it true.
I will tell you this, and make no mistake about it: when nurses leave nursing, there is no longer anything about them that is special. But again, it's just my opinion on things. Nursing boards call NPs advanced nurses. The nursing profession, hails the NP (cuz they're just about like doctors!).
Nursing (and medical) boards license NPs as APRNs along with CNM, CNS, and CRNAs. If you are unsure what licensure is, there are excellent resources available via Google.
As for not being special anymore, you are entitled to your opinion on that, I am sure as someone who has left nursing a few times you understand that.
I don't compete with doctors, personally. Personally, I totally respect them and consider myself far less educated and incapable of doing what they do.
Professional respect is a good thing, but in this case I am not sure how it applies as you don't have the education or experience (or license) to be capable of acting in the provider role.
But as a nurse, I also know that I do things they cannot do--or will not do. And that's my domain. I am with the patient. I care for them; I advocate on their behalf, and I do for them what they cannot do for themselves. I educate them, and I make for them an environment where they can become healthy again or be as comfortable as possible if they can't. I follow the MDs orders and I make nursing diagnoses and perform interventions on those diagnoses.
You are an RN and you practice within the RN scope. Just like APRNs practice within the APRN scope.
The modern healthcare model must have an MD and an RN and everyone else is an assistant to one of them.
NPs see more than 1 billion visit per year and in 22 states they are fully independent providers. Moreover, most outpatient clinics don't have an RNs or LPNs on staff, with your "bedside" blinders on you miss the fact that the majority of healthcare happens outside the hospital.
But, hey, go be an NP and make as much money as you can, and enjoy what you do. Just don't think you're the same thing as a bedside nurse.
Define "bedside" for us.
And thanks, I love my job. For what its worth, and so you understand what the role outside of the "bedside" is, I am responsible for the health of more than 2500 people as a PCP and I spend 8+ hours a day standing next to an exam table doing my best to keep people out of the hospital, healthy, happy, and alive.
Maybe I am missing something, but I have not observed much egotism among NP's or other APRN's. In no way am I any better than other nurses, I have just been lucky enough to have found my niche. By the necessity of needing to make a living, I kept pursuing my credentials. There was definitely some luck involved, or fortuitous circumstances. As a Christian, I think of it as grace.
I don't look down on the bedside RN, quite the contrary. I tried it, and didn't have the emotional or physical stamina.
I believe we all each made differently by the Creator for a reason. We all have a part to play. All roles are needed.
I actively seek out nursing staff in the LTC facility and I value their opinions about the patients. Although I occasionally have to disagree with certain things, I do it respectfully.
Perhaps there are a few APRN's out there that have let their salary go to their head, and they have gotten snooty. They don't remember where they came from. It is too bad.
Perhaps there are a few NP's that have taken a page out of the MD's egotistical play book. That is also a shame.
Since the inception of the NP role, now some 50 years, NP practice has been expanding in scope, and in the level of independence. Although some people are against it, this is likely to continue, due to the need in under-served areas and specific populations.
When I started nursing school 30 years ago, several people told me that I wouldn't make it. They didn't mean I would fail the program, they couldn't picture me working successfully as a nurse.
Here I am, still at the bedside, in an expanded role. Or whatever you want to call it.
Are NPs equal to physicians? That is tough to answer, but personal factors can be more important specific degrees.
Just as an example, several local nursing homes were paying a psychiatrist a monthly fee to visit weekly and evaluate their patients. The Doctor was accepting the money, but not showing up at the facilities for months at a time. The residents were not being seen.
My definition of "bedside" nursing is "direct patient care." Care...CARE. Nurses are in the profession of providing CARE. So, a school nurse is at the bedside when she is seeing students, a home health nurse is at the bedside when she is in someone's home--providing CARE.
Caring is the domain of nursing. Diagnosis and treatment is the domain of the MD. The problem, which is systemic in nursing, is that the nurse considers the MD above her or him in both domains. OR, the nurse considers the MD's domain to be superior because they have more authority, money, prestige, education, and they get to be rude to nurses without consequence.
So, only a special person is going to be able to see that because of the lower status, the nursing domain is greater. But that takes faith, because it's not readily evident upon examination, but there isn't much faith these days. And these days, the idea that the first shall be last and the last first is considered erroneous.
But of course, in my opinion, as soon as you remove yourself from a relationship with God and Christ, then all that's left is the world. And in the world, the MD rules in healthcare, and so nurses set out to be "just as good as doctors." And the whole profession is systemically bent that way, and so the advanced nurse is the more "doctorly" nurse. You even see this bias in the higher levels of nursing education and other areas of APRN.
A nursing school professor may have a Ph.D., but she's not an NP now is she?
A CNS is considered a nearly worthless waste of a Masters Degree these days.
And they actually had the gall to sell nurses the D.NP. Why?
So, here's my take on the greatest most advanced nurse possible. A nurse who obtains certification in her field, goes to school to become a CNS in her specialty, chooses to remain at the bedside, or if a supervisor, still takes a patient load each shift.
However!
The CNA who takes pride in their job and does the best they can each shift is still greater.
Because God is in the quanta of care. God is found in each and every moment when one human being feels compassion and does just a little more than they have to for the benefit of another one of God's creatures. This is most acutely present in ADL care--which is the domain of the CNA.
Again, this is just my opinion, and I appreciate the platform in this string to express it. Thank you for reading it.
As for me being judgmental. I'm not judging any individual in here. This is a discussion post about a broad subject matter. So, don't try to impugn my Christianity for the case I'm trying to make in this post as if somehow that will shame me into shutting up.
Individuals are individuals. I judge no individual. I'm talking about the broad concept of what is or is not an "advanced" practice nurse.
Besides, God knows there are much better reasons to believe I'm a bad Christian (pun intended).
You keep saying you're not being judgmental, but you are oozing judgment, condescension, superiority, and criticism from every pore in every post. You can't stop judging and criticizing people who don't adhere to your specific values and standards. What is the point, exactly? You're entitled to your opinion, and you've stated it. It's not like you're going to convince any of the rest of us that your view is the correct one. What's the point of continuing to flog the topic?
You keep saying you're not being judgmental, but you are oozing judgment,
No. You and I have different definitions of what it means to judge someone. The reason there's even a morality about judging people is that Christ told us not to judge. But Jesus meant it as moral judgement. I don't morally judge anyone. This is a discussion about the nursing profession and what makes the most "advanced" nurse. It has nothing to do with moral judgement at all. In fact, when I read a post in here I find morally repugnant, I don't even comment on it.
So, yeah, I'm making judgement about nursing in general, but not about the individuals in here who may be NPs or any other APRN. Their morality is between them and God.
condescension, superiority, and criticism from every pore in every post. You can't stop judging and criticizing people who don't adhere to your specific values and standards.
What is the point, exactly? You're entitled to your opinion, and you've stated it.
It's not like you're going to convince any of the rest of us that your view is the correct one. What's the point of continuing to flog the topic?
Because...this is a discussion board. People--like you--respond to what I write, so I respond back. That's the way this computer game works. Deal with it, and quit whining. No one forced you to participate. What do you think? That I'm just going to shut up and let you control the field? Why should I?
EGspirit
231 Posts
Not true. I tried to go back to being a tech. The closest I felt to God was when I was a CNA in the dungeon of a nursing home where I first started. But I've been told by two different hospitals in my area that they will not hire a nurse as a tech--they say they can't.
And I take that as a sign that the calling I received to be an RN is something I have to live up to whether I want to or not. But I envy the CNAs. Or at least I envy their position in the spiritual scheme of things.
In my opinion, a CNA who works at the same pace I do for my patients is better than me. You won't ever understand that. It's lost on you, I know it. I'm not judging you for that--it's just a fact.